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Tips For Running With Metatarsalgia

Metatarsalgia can happen to anybody, but it’s more common in athletes. This is especially true for runners.

Runners may find that their runs suffer when there’s pain in the forefoot. However, you can still run comfortably and with manageable or reduced pain when you have metatarsalgia.

Let’s have a look at some tips for running with metatarsalgia and how to manage the pain.

What Is Metatarsalgia?

Metatarsalgia is the medical term that’s used to describe pain and inflammation in the ball of the foot. The pain you experience with metatarsalgia is often a symptom of an underlying condition and not a foot condition on its own.

When the metatarsal phalangeal joints or the metatarsal heads become irritated and inflamed, you’ll experience pain when pressure is placed on your forefoot.

Metatarsalgia develops over time, and most commonly affects the base of the second toe, but it can also affect the third and fourth toe as well. The pain of metatarsalgia can vary from mild to severe, which can interfere with your daily activities.

Potential Causes

In most cases, metatarsalgia is caused by an overuse injury, it’s often not caused by just a single factor. Metatarsalgia can be caused by a combination of several factors that lead to pain in the forefoot.

Taking part in high-impact activities such as running, playing basketball, tennis, or soccer, all place the foot under excessive pressure. The repetitive motion of these activities can irritate the cartilage and soft tissues around the bone, causing pain in the forefoot.

You may be at increased risk of developing metatarsalgia if you have weak extensor muscles or tight calves and Achilles tendons.

Existing foot conditions such as flat feet, high arches, a second toe that’s longer than the big toe, or a hypermobile first foot bone, can place the metatarsals under excessive strain. The added strain can irritate the surrounding soft tissue, leading to pain in the forefoot.

If you overpronate, this will impact the load on the metatarsals, which could weaken the structure of your foot, placing them under excessive pressure. This will lead to pain and inflammation, especially underneath the metatarsal heads.

Existing foot joint conditions such as hammer toes, bunions, Morton’s neuroma, arthritis, bursitis, and gout will change the way your body weight is distributed. This will cause acute, localized pressure in the forefoot, which could lead to metatarsalgia.

If you run in shoes that are worn out or don’t provide adequate arch support, cushioning, and shock absorption, then you’ll be at an increased risk of developing metatarsalgia.

Shoes that have a narrow toe box will place your forefoot under acute and constant pressure. Over time, this constant pressure will cause the surrounding soft tissue to become inflamed, leading to pain in the forefoot.

Check the fat pad under your forefoot, because as you get older the pad in the forefoot becomes thinner. This makes your metatarsal heads more prominent and more exposed to the shock of your foot strike.

This places excessive strain and pressure on the surrounding joints and the sensitive connective tissue, which causes pain.

Symptoms of Metatarsalgia

Metatarsalgia is a progressive condition that can develop over a long period of time. It often begins to show symptoms immediately after you’ve increased your training load, either in time or in distance.

The first signs of metatarsalgia may be a sharp pain in the ball of your foot, just behind the toes.

It could also be a burning pain, or a dull but consistent ache. This pain usually gets worse when you’re on your feet and eases up when you rest the foot.

These sensations are most commonly felt in the area of the second metatarsal head, but they can also occur in the third and fourth. It may feel like you have a small stone in your shoe that places uncomfortable pressure on the ball of your foot.

These pains may also be accompanied by a shooting pain to the toes, numbness in the toes or ball of the foot, and even a tingling feeling. It may be worse when you flex the foot or when you walk barefoot.

Who Is Most Likely Affected?

Anyone can develop metatarsalgia, but it is more common in athletes whose feet are often under pressure and in high-impact situations. Runners of all levels, especially marathon runners, are often affected.

You’re at an increased risk of developing metatarsalgia if you participate in high-impact activities such as soccer, basketball, track and field, tennis, and hockey.

Women who wear high heels will also have a higher risk of developing metatarsalgia. The design of high heel shoes shifts your body weight forward in the shoe, placing the forefoot under constant pressure.

What Should Runners Do if They Have Metatarsalgia?

Not only is metatarsalgia a painful condition to run with, but if you continue to run it will take longer to heal. You may even find that you’re unable to run for several months while your foot heals, and it can lead to further complications.

One of the best things you can do is decrease the intensity, weekly mileage, and frequency of your runs.

Incorporate cross-training into your weekly routine with a focus on low-impact activities like aqua running. This will allow you to have longer breaks between your runs, giving your feet time to heal while you maintain your fitness levels.

As the pain subsides, you can gradually increase your runs, making sure that there’s no pain or discomfort during, and after your run.

Spend more time warming-up before you go for a run making sure to stretch your calf, muscles, Achilles, and ankles. This will help increase blood flow to the muscles, which helps with muscle flexibility, and can help prevent muscle fatigue.

Try running on softer surfaces like the grass of parks, synthetic track, trails or even a treadmill that has a cushioned belt.

Look at your foot strike technique, and see if you need to change it. A mid-foot strike is a favorable technique for a lot of runners. Although there are a lot of runners who run with a heel strike and do just fine.

Add strengthening and stretching exercises to your daily routine. This will help to correct muscle imbalances in the foot, strengthen the foot, and ankle which can help protect the metatarsals from impact.

Check your running shoes, and if they’ve done excessive mileage then replace them before your next run. If the cushioning has started to “flatten” or there’s a lot of wear and tear on the outsole then you should replace them.

When Looking for Shoes to Help There Are a Few Features That Really Help

Cushioning

The cushioning in your shoe will help to absorb the shock of impact every time your foot lands on the ground.

Each footstrike causes vibrations to move up through the shoe, and if your shoe has minimal padding, the vibrations will affect the foot muscles, ligaments, and joints.

Choosing a shoe with comfortable and shock-absorbing padding will reduce the amount of shock that reaches your foot muscles and joints.

Instead, the shock will get absorbed by the cushioning and may be recycled to provide energy return, or will be dispersed over a wider surface area to eliminate specific pain and pressure points.

A Wider Toe Box

A narrow toe box will force the toes into an unnatural position, increasing the risk of feeling pain in the ball of the foot. Choose a shoe with a wide toe box that allows your toes to splay.

This will spread the metatarsal bones out and help to ease pain and reduce inflammation in the forefoot.

Add a Metatarsal Pad

Research has shown that using a metatarsal pad is effective in alleviating pain, and allows the foot to heal.

You can add a metatarsal pad to help alleviate the pain. These are small pads that come in a variety of different shapes and are placed either inside your shoe or underneath your foot—under the transverse arch.

These not only provide more cushioning for the ball of the foot, but they help to spread the metatarsal bones and reduce pressure by dispersing weight more evenly. This can provide effective relief from pain and discomfort.

You could also try using a pair of socks with cushioning in the ball of the foot.

Add an Orthotic

If a metatarsal pad doesn’t offer enough help, you can try using an orthotic. These often have a built in metatarsal pad—met pad—that provides support and extra cushioning to the forefoot.

Immediate Treatment After Running

One of the best ways to get ahead of metatarsal pain after a run is to take action to begin treating your feet immediately after your run. You should implement the RICE principle.

After a run, you should rest your feet, which should provide immediate relief from any pain in the forefoot. You can apply ice to your sore foot for 10 to 20 minutes.

If you have compression socks, you can use them now to stimulate circulation and bring oxygen-rich blood to the forefoot, which can help to alleviate pain. Alternatively, you can wrap an ACE compression bandage around your forefoot.

If you can, you should rest with your foot elevated above the level of your heart for 20 to 30 minutes. This will allow for any excess fluid to drain, relieving pain and swelling.

How to Self-Treat Metatarsalgia

When treating your metatarsalgia at home, the end goal is to reduce the pain, inflammation, and swelling so that you can achieve a normal range of motion without experiencing pain.

The RICE principle is an excellent way to treat yourself for bouts of acute metatarsalgia after activity.

But to reduce the chance of it becoming a bigger problem, you should do exercises to strengthen your foot and ankle.

This will better support the foot and reduce the chance of weak joints further aggravating the pain of metatarsalgia due to the foot being out of alignment.

You should also consider doing exercises to improve our balance, as this can help you to keep your feet in proper alignment.

Strength Exercises

Do the following exercises a few times a day to strengthen your feet and reduce your chances of suffering from metatarsalgia pain during or after a run.

Plantar Sling Strengthener

To do this exercise, you will need a resistance band and somewhere to anchor it in a loop. A desk leg or chair leg will be ideal.

Once your resistance band is anchored, sit on a chair in a normal position, with the arch of your right foot in the loop of the band.

The band’s anchor point should be to the right of you, with the band stretching to where you’re seated.There should be resistance in the band as you hold it with your foot.

Plant your heel firmly on the ground. Then, pull the band—going against the resistance—by rotating your heel on the ground and moving the arch of your foot towards your body.

Then return to your starting position. Repeat this 10 to 15 times. Then reposition yourself so you can do the same with your left foot.

You can work up to doing 30 reps on each foot at a time.

Arch Strengtheners

To strengthen the arch, there are two kinds of exercise you can do. For the first exercise, you will need a marble.

Place the marble on the ground and sit on a chair in front of it. You want to pick the marble up with your toes, hold it for 5 seconds, and then place it back on the floor.

You should try to pick it up with each toe, beginning at the big toe and moving towards the smallest toe. Repeat the full progression—all five toes—three times in total. Switch feet and do the same.

You can also use an entire bag of marbles for this exercise. Place 20 or more marbles on the floor, and one at a time, pick them up and place them into a bowl or cup. Repeat this process three times.

For the second exercise, you will need a washcloth or a small piece of cloth. Place it on the floor and sit on a chair in front of it.

Grad the cloth with your toes and scrunch it up. Hold it there for five seconds and then release it. Repeat this 10 to 15 times, and then switch feet.

You can also do this exercise with a towel. Place it on the floor in front of you, with your toes positioned right on the edge of the towel. You will need to curl your toes and scrunch the towel so that it moves closer to you.

Pull the towel closer to you—you should be able to do 8 to 10 repetitions before the towel is close to you—and then use your toes to push it further away again.

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Cortina, Rose E., et al. “Gastrocnemius Recession for Metatarsalgia.” Foot and Ankle Clinics, vol. 23, no. 1, 1 Mar. 2018, pp. 57–68,
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